As magnetic as he was versatile, Robin Williams entertained young and old generations alike for decades, starring in roles on all points of the emotional spectrum—from comedic roles in Mrs. Doubtfire and Jumanji to raw, heart-touching roles in Dead Poets Society, Good Will Hunting and Patch Adams.
He seemed as big as life itself. But on August 11, 2014, Robin Williams – king of comedy, father, husband and friend – died by suicide at the age of 63, sending shockwaves across the globe.
Unfortunately, his story of “late-in-life” suicide is all too familiar to many. Suicide among older adults is higher than any other age group—while at the same still under-recognized.
Contrary to the belief this is a young adult issue, suicide rates actually increase with age, and older adults are at the highest risk, with 20.12 suicides per 100,000 individuals. In fact, while older adults account for 12% of the US population, they account for 18% of all suicide deaths.
Risk factors of suicide in older adults
Robin Willliam’s wife, Susan Schneider, told People Magazine shortly after his death that, “It was not depression that killed Robin. Depression was one of let’s call it 50 symptoms, and it was a small one.”
She was right. Robin Williams had indeed suffered a lifelong struggle with depression, but an autopsy revealed it may have been the Lewy Body disease (LBD) fronting as Parkinson’s disease that was the true precursor to his suicide.
While it’s commonly assumed depression is the most salient risk factor of suicide in older adults, it’s much more complicated than that. Research divides suicide risk factors in older adults into four categories:
Physical health risk factors
Physical ailments put older adults at risk for suicide, and this risk has a cumulative effect; risk increases as an individual’s number of chronic and acute conditions increase. For example, research shows that older adults with three physical illnesses were three times more likely to commit suicide than those with no diagnoses. Older adults with seven or more conditions were at approximately nine times higher risk.
As in the case of Robin Williams, the diagnosis of a life-changing illness can also trigger suicidal ideation (i.e., suicidal thoughts). Several months before his suicide, Robin was diagnosed with Parkinson’s disease. The autopsy would later change the diagnosis to LBD, but that initial diagnosis was enough to send Robin into a tailspin. An excerpt from his biography, Robin, described the situation:,
“To Robin, it was the realization of one of his most deeply felt and lifelong fears, to be told that he had an illness that would rob him of his faculties, by small, imperceptible increments every day, that would hollow him out and leave behind a depleted husk of a human being.”
Psychosocial risk factors
As with other age groups, stressful life events put older adults at higher risk for suicide. However, with older adults, these stressful events are usually related to aging and include events such as:
- Illness
- Functional impairment
- Death of spouses, siblings and friends
- Financial problems and employment change
Perhaps most impactful is the loss of or lack of social connectedness that unfortunately often goes hand-in-hand with the aging process in our society. Multiple lines of research show the following social factors increase the risk for suicide later in life:
- Living alone
- Lack of participation in community activities or organizations
- Lack of a hobby
- Lack of friends and family to confide in
The Centers for Disease Control (CDC) identified “social connectedness” as a key strategy for preventing suicide at all ages:
“Increasing connectedness among persons, families and communities – including service, funding and advocacy communities – is likely to have a universal as well as a targeted effect on suicidal behavior. By supporting healthy interpersonal relationships … and by encouraging communities to care about and care for their members, the population at large is likely to experience more positive health and well-being, resulting in lower risk of suicidal behavior.”
Yet, even if an older adult feels connected, many struggle with a feeling of being a burden to friends and family, which is a large risk factor. n fact, the Interpersonal Theory of Suicide proposes two main factors create the desire for suicide: decreased feelings of belonging and perceived burdensomeness. While these are risk factors unto themselves, they’re particularly dangerous when both are present in the older adult’s life.
Mental health risk factors
Psychiatric illness – depression, in particular – puts older adults at a higher risk for suicide, and research shows a psychiatric diagnosis is present in most suicides (71 to 97%).
Cognitive deficits, such as LBD and other types of memory-related impairments, also put older adults at suicide risk. The diagnosis of dementia itself is extremely distressing, especially if the older adult realizes what’s happening: “Robin was losing his mind, and he was aware of it,” Schneider said about Robin Williams. He wanted a “reboot for his brain.”
Environmental risk factors
Quite obviously, access to lethal means (e.g., firearms and/or a large cache of medications) is a risk factor for suicide in older adults. Statistics show older adults have the highest percentage of completed suicides than any other age group—largely because older adults choose more lethal methods, such as firearms. Also, many older adults are more medically compromised, thus increasing the likelihood a medicine overdose suicide attempt will be successful.
Signs and behaviors to look for
Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York, corroborated Schneider’s argument that depression was not the key contributor in her husband’s suicide. Kennedy told The New York Times that depression is not the only precursor to suicide:
“If you consider only major depression as the antecedent of elder suicide, you’ll miss 20 to 40% of cases in which there is no sign of mental illness.“
In a recent symposium, he also emphasized that family members, friends and caregivers are the first to detect and defend against suicide. “This is not simply a doctor’s problem,” he said. “We need to think of elder suicide more as a social problem and look out for individuals at risk.”
As a caregiver, be aware of signs and behaviors that may point to suicidal ideation in seniors:
- Expression of depression or hopelessness
- Recent loss of independence
- Diagnosis of a life-altering and/or a terminal medical condition
- Being socially isolated
- Recent death of a loved one, or disharmonious family issues
- Being unable or unwilling to adapt to change
- Exhibit risky or impulsive behaviors
- Increase in substance use or abuse
- Previous suicide attempt
- Statements indicating the benefits of dying (e.g., “Life would be better if I weren’t around,” “My family would be better off if I died,” “I don’t see any point in living.”)
- Giving away valuable possessions
- Uncharacteristic emotions such as anger, cynicism, bitterness, impulsivity
Preventive measures
As a daily caregiver, you are in a unique prevention to stay proactive and implement several prevention tactics:
Engage in honest and frequent discussions – According to Dr. Gregory Brown, PhD, a suicide specialist at the University of Pennsylvania, suicide victims in 75 percent of elder suicide cases had told family members or friends that they intended to attempt suicide. If you have any doubt about their safety, it’s imperative to have a conversation to determine their suicidality. The National Association of Mental Illness (NAMI) has an evidence-based guide for this type of conversation.
Encourage attendance at senior centers – Senior centers offer classes that may be related to their hobbies and offer fitness classes appropriate for their level of ability.
Create a structured daily schedule – A structured schedule full of activities provides seniors with a sense of purpose and a source of pleasure, and social activities of any type – such as book clubs, bowling league, local college courses, visiting coffee shops, etc. – are optimal.
Encourage meaningful roles – Volunteering, mentoring and even teaching (in any capacity) can renew an older adult’s sense of purpose, improve social connection, and ward off feelings of burdensomeness.
Join elderly support groups – Other seniors struggle with the same life issues, which is why support groups are an excellent prevention strategy—increasing their sense of belonging and providing a setting where they can confide in others.
Remove access to lethal means – Remove guns and weapons from the home, and limit access to drugs and alcohol. Also, store your loved one’s medications in a single location they do not have access to.
Connect them with mental health care – Although depression in older adults is not difficult to treat, it is more difficult to recognize. Martha Bruce, a professor of sociology and psychiatry at the Weill Medical College of Cornell University in White Plains, New York explained in The New York Times: “Most people think sadness is a hallmark of depression. But more often in older people, it’s anhedonia—they’re not enjoying life. They’re irritable and cranky. Many older people despair over the quality of their lives at the end of life. If they have a functional disability or a serious medical illness, it may make it harder to notice depression in older people.” Older adults are also less likely to accept the diagnosis and adhere to its ongoing treatment, so it’s important to encourage them to seek mental health support when needed.
Support them, but support yourself, too
Robin William’s life and death are poignant reminders that none of us is spared from life’s challenges. His life was truly an expression of opposites, proof you don’t have to be all one way or another, and that nothing in life is black and white. His tragic end serves as a beacon for suicide awareness in older adults.
As suicide awareness among older adults becomes more prevalent, resources and supportive measures will continue to become readily available to caregivers and their loved ones. In the meantime, remember that although you’re the first line of defense and the eyes and ears of your loved one’s suicide risk, you’re not alone. Please reach out and get the help you need when you need it.
